This article articulates the use of antacids, which induce irregular heartbeats and plaque development in the arteries, and also raise the risk of cardiovascular disease in GERD patients.

The increase in cardiovascular diseases (CVDs) in India is mostly attributable to sedentary lifestyles and the use of highly processed, unhealthy diets. Many celebrities have passed away from CVDs in recent months, bringing this issue back into the spotlight.

In recent years, the incidence of gastroesophageal reflux disease (GERD), often known as acidity, among Indians has increased to 30%. According to experts from Stanford University and Houston Methodist, persons who use proton pump inhibitors (PPIs )such as antacids are 21% more likely to get a heart attack than those who do not. 

Cardiovascular diseases and antacid use

Acid reflux: While antacids are a popular over-the-counter drug and are typically safe and well-tolerated, they have been related to cardiovascular disease in patients who suffer from acid reflux because of their overuse.

CVD: Antacid active components include inhibitors that may be a silent cause of CVDs in people with GERD. Proton pump inhibitors (PPIs), a kind of antacid medication, are often used for a variety of diseases.

Heart attack: Those who use antacids are 16–21% more likely to have a heart attack than adults who do not use antacids, according to research. The endothelium of blood arteries may be negatively affected by PPIs.

Use of PPIs and ordinary antacids on a regular basis

1. Several studies have linked pantoprazole to coronary artery disease since cardiac chest discomfort is usually mistaken for acidity.
2. Patients with persistent heartburn despite using antacids should receive a cardiac assessment, particularly if they exhibit cardiac risk factors.
3. Multiple processes, including a loss in nitric oxide bioavailability, electrolyte imbalance, and interaction with some anti-platelet drugs, might be triggered by the increased use of antacids and proton pump inhibitors.

Food choices and over-the-counter drugs like antacids are important

In accordance with the Drugs Rules of 1945, some drugs, including antacids, are permitted to be supplied over-the-counter (OTC) by merchants with a valid license.

1. It is widely available over-the-counter, and many people use it before seeing a physician. A minimum of 20% market share is held by antacids. The antacid market is expanding. Antacid sales over-the-counter (OTC) have surged as a result of the rise in acidity problems since the pandemic.
2. Diet plays a key role in explaining why there has been a rise in the use of antacids. The way of life is one of the most influential causes of acidity. Food is the most prevalent reason. Citrus fruits, tomatoes, onions, chocolate, coffee, cheese, and peppermint all create acidity when consumed.
3. In addition to being a source of discomfort, spicy foods and big meals and being overweight also enhance acidity.
4. Obesity, tobacco use or smoking, spicy and non-vegetarian diets, connective tissue disorders, and the use of antibiotics, NSAIDs, antidepressants, and osteoporosis drugs are the leading causes of gastroesophageal reflux disease (GERD).
5. A balanced diet is required for maintaining health and preventing sickness.
6. A nutritious diet may enhance an individual's long-term health, yet disregarding the significance of nutrition can lead to health problems. The incidence of heart disease is rising rapidly, and the leading causes include an unhealthy lifestyle, physical inactivity, an unhealthy diet, smoking, alcohol drinking, and improper sleep patterns.
7. If the Indian diet is followed correctly, GERD will not develop; nonetheless, the addition of spices, carbonated beverages, and lipids causes acidity.

Antacid side effects that are less well-known

1. Although OTC antacids may effectively treat acidity and indigestion, long-term use of these drugs may have negative health effects. Regular use and consumption may lead to calcium and magnesium deficiency, and long-term use has been related to kidney issues and reducing the efficacy of other drugs.
2. Many antacid adverse effects are induced by improper administration. Calcium is present in several antacids. Calcium overdose may occur if the acceptable dosage or duration is exceeded. An excess of calcium may cause nausea, vomiting, mental status changes, and kidney stones. It may also result in alkalosis, a disease in which the body does not produce enough acid for appropriate function.
3. Antacids may only alleviate symptoms, not cure the problem.
4. Antacids assist alleviate the symptoms of hyperacidity, particularly abdominal burning, bloating, and epigastric pain, but they should not be used on a daily basis.
5. Antacids (PPI) are safe when taken in the proper quantities, by the right patient, and for the right reason; but, excessive usage will result in adverse consequences. Kidney problems, bone density loss, opportunistic infections, magnesium shortage, and B12 deficiency are among the adverse consequences.
6. Because antacid liquids include salts that might create difficulties if taken unsupervised for an extended period of time, the medication should only be used as recommended.
7. Long-term use of antacids has been linked to renal problems. Widespread usage of acidity prescription pills among Indians; long-term use of these tablets may be dangerous and have a significant influence on one's health.

PPI indications

1. If PPIs are administered, they should be taken for a limited time (4 weeks, followed by 1 to 2 weeks of dose reduction) and only for very specific causes for which there may be no other treatment, such as GERD, stomach and duodenal ulcers, and Helicobacter pylori.
2. In the majority of instances, H2 antagonists provide a safer option. For long-term control of stomach acidity, H2 antagonists like ranitidine may be coupled with neutralizing antacids.
3. Barrett's oesophagus, Zollinger-Ellison syndrome, erosive esophagitis, and individuals with a documented history of stomach ulcers may need long-term treatment with nonsteroidal anti-inflammatory drugs. In these few instances of prolonged usage, the smallest dosage feasible should be administered.
4. PPIs with little influence on hepatic metabolism are favoured for patients on multiple-drug regimens with medicines that are heavily processed via the liver (ie, esomeprazole).

Step-down therapy guidance

1. In light of the growing evidence linking chronic PPI medication to unfavourable clinical outcomes, clinicians should limit PPI usage to FDA-approved short-term use for the listed conditions.
2. In individuals with criteria for persistent PPI usage, surgical or minimally invasive treatments are alternatives for treating GERD. However, the majority of patients who take PPIs chronically do not have a good reason for continued usage and should be tapered using "step-down treatment." There are written guidelines for step-down treatment, but they are seldom followed.
3. In one method, patients begin taking a long-acting H2 antagonist (such as Zantac, ranitidine; 150 mg daily) a few days before quitting the PPI, and afterwards; after stopping the PPI, a neutralizing antacid (such as Tums, 500 mg calcium carbonate, 1–2 tablets every 4 hours as required) is added.
4. The combination of an H2 antagonist and a neutralizing antacid should prevent the return of acidity after discontinuing PPI therapy.
5. In addition, patients should receive normal lifestyle suggestions to minimize GERD, such as lowering weight, limiting alcohol and coffee consumption, avoiding heavy meals at night, avoiding tight clothes, quitting smoking, and sleeping with a head up.
6. Given that PPI medication may inhibit endothelial NO production, it may be advantageous to enhance vascular NO by consuming nitrate-rich foods such as green leafy vegetables and beets.

Disclaimer- The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of M3 India.

About the author of this article: Dr Monish Raut is a practising super specialist from New Delhi.